Seven months after she began chemotherapy for breast cancer - after she had already grieved the loss of her hair and the loss of her breast - Marie Knowles began to be consumed by thoughts of her own death.
It got so she could hardly drive by the cemetery where her twin grandsons were buried. She and her husband had bought burial plots there, too, and now it felt like the cemetery was trying to suck her in as she drove past.And then one day, about nine months into chemotherapy, she stopped the car, got down on her knees in front of the headstones and began beating the neatly manicured ground that was waiting so patiently for her. `I'm not ready for this," she screamed. "I have too much living to do and too many grandchildren still to see."
Now, 16 months after her breast cancer was diagnosed and three months after completing chemotherapy, Knowles can look at the longest year of her life and say that, in its own perverse way, her cancer taught her how to live.
"I will not lie and say I'm glad this happened to me," says Knowles, sitting in the family room of her new home in Sandy. "But I think I'm much better off."
She has learned, she says, how to let go and how to be more open with the people she loves.
Like other women, Knowles knows that the aftermath of breast cancer is full of lessons and complexities. To help patients like Knowles, and their families, deal with the multiple issues of the disease, Holy Cross Hospital is sponsoring a "Life After Breast Cancer" seminar on Tuesday, Oct. 23. Co-sponsors are the American Cancer Society and Nordstrom.
Boston surgeon Susan Love, author of "Dr. Susan Love's Breast Book," will discuss the diagnosis, treatment and experience of living with breast cancer. "We're told that if you're knowledgeable about your illness, and you talk about it, your chances of survival are greater," says Knowles.
But on the morning of June 23, 1989, when she first noticed a lump in her right breast, all she knew was that she was scared. A monthly self breast exam - the kind doctors recommend - might have detected the lump sooner, but, like a lot of women, Knowles always found reasons why she didn't need to bother: Her breasts were too naturally lumpy, and besides, she didn't fall into the high-risk group (she had no family history of breast cancer, had started menstruating early, had given birth to her children before the age of 25).
Even though 16 months have passed, Knowles says she can still remember exactly how her mind froze when the phone rang in the operating room with news that her biopsy was malignant.
"All we hear and read are statistics," says Knowles. "You don't know there are so many survivors until you get (breast cancer) yourself. Then you find out that everyone has a mother or an aunt or a sister who has survived. . . . But when you hear the word cancer, it's synonymous with death. You think you're going to die."
Before she developed cancer, she says, her biggest fears were "dying in a car accident, drowning or dying in a plane crash." But now that she has faced death head on, she says, these fears have vanished.
"That was the beginning of my letting go. . . . I do believe you do eventually have to come to an acceptance of what you can't change."
"I'm tired of being afraid," she says. "I'm so tired of it I'm not going to be afraid anymore."
Knowles regularly attends a self-help group at Holy Cross Hospital. According to Dr. Hugh Hogle, medical director of Holy Cross Breast Care Services, that's one of the best things she can do for herself.
"There is growing scientific evidence," says Hogle, "that women who receive support after being medically treated do better in terms not just of mood but also survival."
The key, he says, is a "consistent, organized, scheduled support group geared to problem solving." In a support group, patients learn how to direct their anger "so it becomes resolved and becomes replaced with determination."
The most important determinant of long-term survival, though, is still early detection, notes Hogle, who stresses the need for mammograms and self-exams.
Because of early detection and improved care, five-year survival rates for women with breast cancer are now, on average, 75 percent.
Hogle will lead a discussion on "Living with the Diagnosis" at Tuesday's seminar, which runs from 8:30 a.m. to 4:30 p.m. at the Marriott Hotel, 75 S. West Temple. The seminar is free but pre-registration is requested. Tickets for lunch and a fashion show sponsored by Nordstrom are $12. For more information, call 350-4000.